Since completing her rheumatology fellowship and research training, Dr. Costenbader has devoted her career to patient-oriented rheumatic disease research. She has served as primary or secondary research mentor for 33 pre- and post-doctoral trainees. Along with her position as Co-Director of the Brigham and Women's Hospital Lupus Center, Dr. Costenbader's mentoring is facilitated by her affiliations with several Harvard teaching and training programs. Moreover, the candidate's multiple ongoing patient-oriented research projects and collaborations, commitment to mentoring, and exceptional institutional resources provide an outstanding environment for the development of junior investigators in patient-oriented rheumatic disease research. This K24 grant would preserve Dr. Costenbader's protected time and relieve future clinical and administrative responsibilities. The new research aims proposed will build upon past work in a large, nationwide lupus population with Medicaid data from 2000-2010. With data on over 66,000 lupus patients in the U.S., these studies will address key unanswered questions about cardiovascular disease risks, medical and surgical care, and outcomes. These important questions include whether cardiovascular disease risks are changing over time in this population, how post-cardiac event and intervention risks compare to those of the general population, whether lupus patients receive optimal cardiac care, and whether hydroxychloroquine reduces cardiovascular disease risks. The inherent sociodemographic variation and high medical risk of this vulnerable population make these studies extremely relevant for ongoing policy discussions about improving healthcare and outcomes. The findings of these powerful studies will inform future . Moreover, the proposed research studies will provide excellent mentoring opportunities. Dr. Costenbader will continue to recruit two to three new trainees into her rheumatic disease epidemiology and outcomes research program each year, and to expand and refine her formal mentoring program using feedback received from trainees, medical care and prescribing practices and seminars and lectures at the Brigham and Women's Hospital and Harvard Medical School. Based on institutional commitment and resources and Dr. Costenbader's successful record in research and mentoring, this K24 grant would greatly augment her ability to expand her existing research mentoring program and to develop the next generation of patient-oriented rheumatic disease investigators.